CHEST Guidelines-Response

Response_chest (13)

Pdf Summary

In response to a critique by Kalil et al, regarding a study on the use of vitamin C, hydrocortisone, and thiamine for treating severe sepsis and septic shock, the authors, led by Dr. Paul E. Marik, defend their findings despite acknowledging the study's retrospective, before-and-after design, which lacked the robustness of a prospective, randomized, blinded trial. They emphasize the ethical imperative to share their promising results, suggesting the combination therapy might reduce global sepsis mortality and calling for further studies to validate their preliminary outcomes.<br /><br />The authors dispute Kalil et al’s claim about the lack of evidence for the safety and efficacy of vitamin C, highlighting various studies that demonstrate its benefits in ICU patients, burn victims, individuals undergoing surgery, and those at risk of kidney issues from contrast agents, without major safety concerns. They assert there’s no significant risk with vitamin C in doses used in their protocol based on extensive practical experience and literature review. High-dose vitamin C treatments are cited as safe, with a cautionary note only for patients with chronic renal impairment due to potential hyperoxalosis, and those with glucose-6-phosphate dehydrogenase deficiency. The authors assert it is unethical not to provide this potentially life-saving treatment to critically ill patients, challenging the critique of their methodology and urging for more research while underscoring the beneficial safety profile of the treatment in contexts similar to their study.

Keywords

vitamin C

hydrocortisone

thiamine

severe sepsis

septic shock

Dr. Paul E. Marik

retrospective study

safety and efficacy

ICU patients

high-dose vitamin C